By Naja Enevold Olsen

Q1: We’ve heard about Leland the doctor, tell us more about Leland the surfer? Do you venture out into big surf or take on Pipeline yourself?

A: Yes, I am an avid surfer myself, I surf almost every day. I have even been known to surf some relatively big waves (maybe 10-20 foot faces). Nowadays though, I tend to shy away from the main crowded breaks (I do try to surf Sunset and Pipeline each year), but I have my own uncrowded spots close to home which I go to mostly. It’s pretty challenging surfing big waves by yourself, which I do often, but after 20 years on the North Shore I know the conditions pretty well. Although, this doesn’t exempt me from getting sent back humbly to the beach by Mother Nature once in a while.

I also take my kids out to the many beautiful gentle breaks we have here in Hawaii. Adam is 9 and Sarah is 6, they both surf in the Menehune contest circuit here. Nowadays the kids start pretty young.

Q2: It’s well known that doctors make terrible patients! I can personally testify to this. I ended up with a huge sea ulcer from a non-healing (eh…poorly tended to) foot wound a few years back in Australia. I also developed otitis eterna, and later ruptured my tympanic membrane. Yet, do you think I stayed out of the water? Eventually, both infections deteriorated, and I had to relent. Antibiotics, analgesia, patched-up with waterproof dressings, repeatedly surfing…inevitably, I ended up a little worse-for-wear. Sometimes you have to stay ashore, rest up, and heel. Well, at least for a few days!

I imagine you’ve had your fair share of cuts and bruises, etc. Have you sustained any serious injuries from surfing? Do you practice what you preach and follow your own advice?

A: I think we as surfers will often push ourselves to the limit so we can be in the water as much as possible. I remember surfing on a medium-size North Shore day several years ago when my front foot slipped off my board during drop in, and I heard a POP. Next came the excruciating pain from a torn hamstring. I continued to surf a few more waves and hobbled to the beach. I sustained a huge contusion to the posterior thigh. As the swell was still up the next day, I duct taped the area and paddled back out, all for a few more waves. Not the advice I would have given to a patient, but I think you’re right, we are often bad patients!

Q3: You’ve been a contest doctor for numerous events, e.g. the Pipe Masters, for nearly two decades now. Witnessing the sport’s progression, in terms of athleticism, e.g. aerials are becoming almost commonplace and the envelope is continually being pushed in big wave settings, this must have heralded some novel injuries? What do you think we can expect to encounter, potential hazards, management issues, etc., as surfing continues to develop? And do you observe any change in the severity of injuries down through the years?

A: I think the number of lower extremity injuries has increased with the new moves, including knee and ankle injuries. Also cuts and lacerations. Surfers who achieve this level of performance are highly skillful, and admittedly can often avoid injury, but this is not always the case. Many aerial maneuvers are often done during windy conditions, and sometimes this will blow the board out of position, placing the surfer in more precarious landing situations.

As far as other developments, such as the advances in the big wave arena, it’s truly amazing to see the paddle resurgence across the world, with committed athletes putting on spectacular performances. Surfers now fly all over the planet chasing storms, trying to raise the bar each time they go out into huge surf. It’s important to remember that they not only have the physical abilities to do so, but they also possess another essential component, that psychological preparedness and extreme desire to go out and pith themselves against massive waves. I recommend checking out “The Surfers’s Mind” by Richie Bennett for more on this. I find this mental aspect intriguing. However, I’m also glad to see more of these gladiators slowly but surely heeding safety calls and wearing flotation devices in giant surf.

The good, the bad, and the bizarre…I imagine you’ve seen it all! Surf-related injuries can be quite diverse. Which story/case has represented…

Q4: …the most serious situation and challenging in terms of management? And what was the outcome in this case?

A: Fortunately my work has been under the relatively stable environment of professional surfing events. We have the contest directors looking at the surf conditions daily and deciding whether to run events or not. We also have the water patrol lifeguards as part of the team. I call them the ‘Guardian Angels’, they can rescue an injured victim out of treacherous surf and have them back on the beach in 60 seconds, theoretically. And of course the professional surfers themselves, being great athletes gives them a the better chance of escaping serious injury.

I think that all of these contributions have made our jobs much easier over the years.

The unfortunate incident of Tuhiti Haumani this last winter was a really serious and dangerous situation which occurred just after the completion of the Volcom Pipe Pro. I was not directly involved, as the event had just finished at about noon this day. That afternoon the surf and wind came up extremely fast and out of an unusual direction, creating particularly hazardous and atypical conditions at the Pipeline area. A number of surfers went out including Tuhiti, he reportedly was hit on the head by his board and knocked unconscious. A number of the professional surfers and lifeguards rushed out to get to him in very difficult wind and rising surf conditions. They finally reached him, but he had been underwater for several minutes. The strong winds created havoc for the nine or so surfers trying to bring him ashore, it was becoming like a river flowing out to near the 3rd reef at Pipeline, a distance of probably ¼-½ mile or more. They lost his body at one point, but were able to recover him again. Finally, they got him to the beach, performed CPR, but no pulse was initially detectable. They did eventual get a pulse in the ambulance and transferred him to the hospital in critical condition. I had just returned to the event site to pick up a few more of things, only to hear what had just occurred from a number of the surfers who had been involved in the rescue, all were very distraught. After several weeks on life-support in the hospital ICU, I understand Tuhiti was repatriated to Tahiti with a tracheostomy tube.

Q5: …your most rewarding in terms of implementing a favourable outcome? And the most outrageous, just-plain-weird, case you’ve witnessed?

A: I feel that rehabilitating the surfers, helping them to overcome their injuries and continue to surf and compete is the best thing we do as Sports Med Physicians. The 2012 Pipe Masters, when Josh Kerr sustained a neck injury following a big over-the-falls wipeout, thankfully had a positive outcome. We brought him to the medical area, evaluated him, and sent him for imaging to clear C-spine injury. He returned to us afterwards and our team worked on him repeatedly with massage and manipulation. He was subsequently able to reenter the competition and continued winning heat after heat, even making it all the way to the finals against Joel Parkinson, the eventual Pipe Masters Winner and World Champion. We are very proud of our part in helping Josh attain that result at one of the World’s most prestigious surfing events.

Q6: Do you have a few useful tips for surfers, in general, in order to stay safe in the waves?

A: Always study and keep an eye on the prevailing conditions, know what you’re getting yourself into. Make sure you understand the dynamics of the break, and know how to get back to shore in case something happens. Know before you go!

Q7: Lastly, for how many more years are we likely to see you providing your expertise at North Shore contests?

A: I have been lucky enough to be attending physician at every Pipe Masters and Pro event since 1997. Wow, time goes by so fast! I still enjoy every moment covering these and other Hawaiian surfing events. It’s a great privilege to be a part of professional surfing. People don’t always realize that there is long season of North Shore surfing events beginning around late October and going all the way through to March. It takes commitment to cover these events, but as mentioned, I really do enjoy working on them. I still love my job as a Family Physician on the North Shore as well. I want to mention that we have a team of health professionals who make up the Sports Med Team for WSL Hawaiian events, working as a group to catering for the needs of the competitors and the events. We have Doctors, Chiropractors, Therapist, Trainers, and other allied healthcare providers. We have students from all across the world who inquire each year about coming over to help us, and many actually do make the trip to be a part of our Sports Med team. Each year the group develops a great rapport, just about everyone walks away with fond memories of contributing to the safe and successful running of events like the Triple Crown.

So back to your question: I feel just as inspired now as I did 17 years ago, and I don’t have any intentions of retiring soon. I love this job, and hope to be around for another 17 or more! I welcome the EASD and its members to come experience the Hawaiian Winter Surf Contests firsthand, we will be happy to show you how we do it here in paradise!

It has been my pleasure, Mahalo and Aloha!

Read Part I of “Pipe Dreams – An interview with Hawaiian Surf Doc, Dr.Leland Dao” here.

Naja Enevold Olsen MD is a surfer and doctor living in Aarhus, Denmark. She is Deputy Editor | Contributor Articles | EASD Marketing and Communications Team and has recently represented her country at the International Surfing Association (ISA) World Surfing Games 2015 in Nicaragua.

By Naja Enevold Olsen

Pipeline has long held a formidable reputation in the surfing world. Its picture-perfect, elliptical barrels belie the fearsome reality of the reef below. When Pacific groundswell detonates on the shores of Ehukai, the feats of surfing athleticism on display can be spellbinding, especially when the world’s elite rally to put on a show at events such as the Pipe Masters. Threading Pipe’s pristine tubes with success requires walking that fine line between triumph and disaster; a foot out of place, a hasty shift of weight to the rail, can determine whether a surfer emerges to glory or potentially meets their maker among coral crags and recesses below. Either way, behind the scenes, a talented team of health professionals are on hand to provide medical support to competitors.

Q1: It seems as if things took off around 1997, after you met two of the then key players within the ASP and Triple Crown of Surfing, Bernie Baker and Randy Rarick. Tell us more about how you came to be involved and why this kind of role appealed to you?

A: My work with professional surfing began after moving to Hawaii with a goal of practicing on the North Shore of Oahu. I had been accepted to the Family Practice Residency program at the University of Hawaii, and had met and treated several surfers already during my training. Upon completion in 1997, I started practicing with a medical group who opened an office for me in Haleiwa. The North Shore is a small community, everyone knows each other, so I approached Randy and Bernie about providing medical care at the events and they said ‘sure’. That year I also began covering the Triple Crown of Surfing. In addition, I was asked by then ASP CEO Graham Stapelberg to cover the Makaha World Longboard Championships. Back then the Greville Mitchell Surfing Foundation were a sponsor of the ASP, this included providing sponsorship for a physician and chiropractor at each WCT event. I have been involved with professional surfing ever since. To this day, I still love every moment working with the surfing community. I was lucky to have been invited to provide medical support at events in California, Australia, Japan, Europe, South Africa, and Tahiti. Obviously, it is not a full time job, but has been a great complementary adjunct to my medical practice here on the North Shore.

Q2: You have worked along side many different teams of water patrol/jet-ski rescue operators, lifeguards, and contest doctors at numerous events such as the Pipe Masters. Teamwork is a key component and you’ve worked with Dr.Clay Everline MD over the years, and more recently with Dr.Terry Farrell DO, both of which contribute to the EASD. What would you say are the attributes of a good Surf Doc?

A: I think the most important thing is to be readily available, and having an intimate understanding of the needs of the surfers and the surfing events. Over the years, we have developed a program which caters to the specific needs of surfing athletes, ranging from the professional level to amateur. Today, our event medical support and our Surfing Sports Med Program here on the North Shore is, I feel, one of the best.

Q3: Down through the years you have been involved as event doctor in many professional surfing contests. Is there a particular story/case/experience that left an impression on you? Something that has perhaps stuck with you?

A: I’ve got lots of stories, here are a few:

I think one of the most admirable traits about surfers is their passion and determination to be in the waves. I remember having to stitch up one competitor twice in one day! He had cut his leg, and ruptured his eardrum, but made it through his heat. He went out again, yet this time he hit his head and sustained a big gash to the forehead. Unfortunately, that was his last surf of the day.

During a recent Pipe Masters, the first day was huge 8-12 foot surf, we were all on edge watching nervously at these surf gladiators out there tackling these monster barrels. Suddenly, we were called down to the water’s edge to attend an injured competitor who had dislocated his shoulder. Fortunately, we were able to put the shoulder back in place right away on the beach (not an easy thing to do with a crowd glued to your every movement). A huge crowd had gathered on the beach to watched and live TV were broadcasting what was going on. Just as we had heard the clunk of his shoulder going back in, he asks us, “Is it in?”, I replied, “Yes it’s in!”. Next thing I know, he’s up and saying “Okay, I’m going back out”. We all just looked at each other in disbelief. Before we could say anything he’d started running back to the ocean, with the crowd cheering him on, television cameras rolling! Unfortunately, several minutes later he came back in, with (no surprises) the same shoulder dislocated.

I have been fortunate to have seen nearly all of the world championship titles crowned over the years, a few at Sunset Beach and most at Pipeline. It is always great to see the title race come down to the final event of the year. The Kelly Slater and Andy Irons showdowns were always the most epic battles of sheer talent and courage. The year the world title came down to AI and Kelly’s finals at the Pipe Masters was truly spectacular, an epic seesaw battle in the final heat of the year. To watch the crowning of the world championship in that fashion was a real treat to behold.

I remember the first year I went to Teahupoo the swell came up very quickly at the Tahiti Pro Trails. The event organizers were ready to send out the trialist into massive barreling waves. We waited in the channel until the mid-morning for Andy and Bruce Irons to arrive from the airport. A few guys had been catching waves here and there but when Bruce and Andy paddled into the line-up, it was a whole different show, they gave the most incredible big wave performance at Teahupoo that year. It was amazing to see the performance in person.

Q4: This year’s Billabong Pipe Masters was held in honour of former World Champion and Hawaiian pro-surfer, Andy Irons, who tragically passed away in 2010 at 32 years of age. What would you say has changed, if any changes are evident, in professional surfing in the wake of his tragic death?

A: I think if anything good can be said about the tragic early loss of Andy Irons it is that Professional surfing does do more testing of random and suspicious athletes under WADA guidelines. Pro Surfing is a relatively ‘clean’ sport, it is the responsibility of those of us who oversee the sport to keep it this way. Andy was one of the greatest competitors and performers in surfing history, we hope his early demise will be a reminder of what devastation both illicit and performance-enhancing drugs can potentially do to a person.

We just completed the Pipe Women’s and Jr Pro event last month, it is always great to see the women as well as the new school of young Junior surfers. Congrats to Keala Kennelly for coming out of retirement to win the Women’s event. Also, it’s a real treat to see the young guns really charging at the Jr Pro. This year the final was a real “nail biter”. Josh Moniz had a solid lead throughout, until Benji Brand caught a nice barrel to take the lead. Then, with less than 20 seconds left, Josh caught a very average left, and punted a massive backside air reverse 360 as the final horn sounded. This was exactly the manoeuvre Josh needed to clinch the win, and he did, what an absolute clutch performance! In my opinion, this type of surfing, with acrobatic, aerial manoeuvres on demand, is the most significant change to the sport of competitive surfing in recent years, and will carry performance surfing into the future.

Tune in next week to catch Part II of our interview with Hawaiian Surf Doc, Dr.Leland Dao.

Naja Enevold Olsen MD is a surfer and doctor living in Aarhus, Denmark. She is Deputy Editor | Contributor Articles | EASD Marketing and Communications Team and has recently represented her country at the International Surfing Association (ISA) World Surfing Games 2015 in Nicaragua.

Professional Medical Support Teams for Athletes

Increasing professionalism in surfing has widespread implications, not only for surfers, but also for the health professionals who look after these athletes at contest events. Dr.Leland Dao DO discusses this issue and highlights the key role played by medical support teams in the above clip.

“As the world’s largest and leading collective of medical professionals in surfing the European Association of Surfing Doctors (EASD) is actively contributing to and defining standards for surfer welfare. By connecting health professionals representing all medical specialties with a passion for surfing and the ocean, the EASD seeks to share knowledge, expertise, and experience with the global surf community. In a fast developing global surf community, the EASD’s quest is to “Keep the surfer healthy and safe” through numerous activities, such as: treatment in day-to-day practice, serving as contest medical personnel in both professional and amateur surfing arenas, delivering training courses for medical lays and health professionals alike (Surf Life Support™), conducting scientific research work and publication, defining evidence-based standards within the specialty and the sport at large, and convening the Annual Conference in Surfing Medicine where health professional from all over the world convene. Share the passion? See you on one of the various EASD events and in the water!”

The European Association of Surfing Doctors (EASD)

PRESENTS

“The Surfing Medicine Global Outreach Report 2015”

The European Association of Surfing Doctors (EASD) is proud to present the 2nd Surfing Medicine International Community Global Outreach Report. The EASD is a medical, non-profit organization grounded in a commitment to excellence, in the application of state-of-art knowledge, evidence-based science, and transparency to surfer welfare, and in staging 100% certified Continued Medical Education (CME) educational events.

Since our founding four years ago, 120 projects have been successfully realized. We started out with “A Passion for Surfing and Medicine”; with time, dedication, and a lot of hard work, we have developed into the leading medical organization committed to “Keeping the Surfer Healthy and Safe”.

EASD Global Outreach 2015, only a few white spots left!

Presently, professionals from 31 countries working 24/7 on original science and surfing medicine research are establishing the foundations and necessary framework for new, evidence-based standards within surfing, and implementing the gained knowledge and experience won in order to contribute meaningfully to the further improvement and professionalization of surfing medicine and the sport we love dearly. From 373 in 2014, we have grown to 510 members in 2015, representing the largest community of surfing doctors worldwide.

In 2014, the EASD reached out to the big wave community by “Taking Surfing Medicine to the Extreme” at the 3rd Annual Surfing Medicine Conference in Ireland. Designed and delivered by 2013 Billabong XXL Finalist, Peter Conroy, the EASD organized the world’s first multiple-specialization, medical-response PWC rescue training for surfing, sharing our knowledge, experience, and defining new standards and approaches to the safety, prevention, and treatment of emergency situation in big wave surfing.

Convening Conferences with unique people, realizing projects new to the world of medicine and surf science, and consistently exceeding the expectation of expert collaborators; by building on the knowledge of hundreds of medical doctors, academic professors and applied scientists, allied health professionals, and educating the surfing public, whether the everyday surfer or top professional surfing athletes, the EASD is growing from strength-to-strength year on year.

With 2015 well under way, the EASD and the Surfing Medicine International community is once again preparing for the gathering of minds and surfboards at the 4th Annual Surfing Medicine Conference. This year, returning to “The Core of Surfing Medicine”, we are unifying the world’s leading experts on drowning prevention and delivering another first in the form of the world’s largest Drowning Resuscitation Workshop yet seen. Stoked? We are too!

See you in Pays Basque (France) at Conference 2015 in Anglet/Biarritz this September!

The EASD

We are proud to show you the latest video portraying the Advanced Surf Life Support™ course. Hit the play button and dive into this challenging, teaching and fun 7-day-course:

The Advanced Surf Life Support™ course features a wide array of topics, such as rescue techniques, drowning and hypothermia, diagnosis and treatment of wounds, rips and currents to name but a few aspects. Developed by the European Association of Surfing Doctors and refined over the years it is the original and leading course in surfing medicine specifically designed for health professionals. Participants will experience theoretical and practical training as-well as land and water based scenarios by experienced surfing doctors, wilderness medics, drowning specialists, and professional surf-lifeguard instructors. YOU can make a difference – are you ready?

“Une courte interview avec Dr.Olivier Chambres” by Rosa Tigges

The Conference Promo Tour has reached its halfway point. The crew have been busy promoting the 4th Annual Surfing Medicine Conference in towns and cities up and down the Pays Basque (France) coast. Next, they cross the border to Euskadi / El País Vasco (Spain).

The Conference kicks off this September in Anglet; whilst in the neighbourhood, the crew took the opportunity to catch up with Dr. Olivier Chambres, one of the speakers at the upcoming event. Dr. Chambres lives and works in Anglet as a Head and Neck surgeon; Ear, Nose, and Throat (ENT) MD; and as a Maxillofacial surgeon in the south west region in a practice in Bayonne.

So, let’s get to know the man behind the lecture!

Olivier is from the coast of the Les Landes region. He studied medicine in Bordeaux and Strasbourg. He is a real sportsman at heart and began surfing at 13 years of age. He also practices Pelotte, a traditional Basque sport, and he is coach of his sons’ rugby team at Anglet Olympique Rugby Club. He and a nursing colleague, also a surfer, formed the medical support team for Basque bull fights. They frequently encountered both blunt force and penetrating trauma injury. Wounds comparable to knife stabbings were not uncommon, often requiring emergency procedures directly on-site. This is how Olivier cut his teeth in pre-hospital response and subsequently graduated with a thesis on emergency medicine in bull fighting.

Surfing Medicine for Olivier means being able to combine professional work as a doctor with his main hobby, surfing. He is keen to share his knowledge and stoke about surfing medicine with colleagues and friends. The importance of surfing medicine in the southwest of France cannot be overstated. In Les Landes, due to the remoteness of some breaks, it is a must know topic. Many spots lay some 30-40km from appropriate medical treatment facilities. Sometimes the nearest ‘urban’ center is a small village that would typically have 500 inhabitants, and lots of spots are only accessible with prior authorisation to drive through the forest directly adjoining the coast; so, if something happens, it’s vital to know more about surfing medicine.

The Annual Surfing Medicine Conference provides delegates with specific, evidence-based information through lectures. In addition, you have the chance to practice surfing medicine in the “hands on” workshops. So, any established or budding surfing doctor can become more acquainted with the wide range of probable situations that can occur whilst surfing or at the beach, giving participants the confidence and capability to prevent adverse events or save lives of surfers and beach users within your own surf community.

Olivier returned to the Basque country in 2005 following seven years in Strasbourg. The lack of waves were compensated for by skiing, also one of his favourite pastimes. Surfing fits perfectly in his daily routine, frequently squeezing in a dawn patrol before going to work. He is a doctor with the medical support team for the Big Wave Competition ‘La North’ in Hossegor, held annually in December and January.

During the summertime, he typically treats anything from two to ten injured surfers per week. In the winter the numbers fall back to one or two per month. The most common conditions Olivier sees in his day-to-day practice are skin injuries and bone fractures caused by boards (either own or others’ boards), fins, or rocks. Olivier also encounters skin cancer, external auditory canal exostosis (surfer’s ear), and sinus infections due to polluted water from the river Adour north of Anglet and Louhabia near Guethary.

It was a pleasure to speak with Dr. Chambres. He will lecture on common Maxillofacial Injuries in the Surf, how they are treated, and their prevention this September at Conference 2015.

Keynote Speakers (A-Z)

Dr. Guillaume Barucq (Basque coast, SW France)

Guillaume Barucq is a 37-year-old surfer and general practitioner from the Basque coast in France. He works in Biarritz, close to some of the best surfing spots that the Basque coast has to offer. In 2008 he launched Surf-Prevention.com, a website originally intended to educate doctors of the risks of surfing, common injuries and how to minimize the risks associated with the sport. Now almost eight (8) years down the line, he is still the editor of Surf-Prevention and is also an occasional blogger for theinertia.com, with a main focus on promoting surfers’ health, the benefits of surfing and environmental protection. He is a firm believer in the role of seawater, sea air and the marine climate in helping to strengthen our health and prevent illness, and is also a defender of the marine environment because our health is intimately related to the health of the ocean.

He is the author of “Surfers’ Survival Guide” and “Surf Therapy”, two very well sold, French-language health books for surfers. He is also involved in surfing medicine research, and in 2007 he published a study on surfing-related traumatology based on 350 patients admitted to the hospital after surfing accidents in the South West of France. Dr. Barucq studies the benefits of surfing for health and the different medical applications of “Surf Therapy” for people with disabilities, autism, cystic fibrosis and other diseases.

Dr. Joost Bierens MD PhD MCDM (The Netherlands)

Dr. Joost Bierens, MD PhD, (The Netherlands, 1954) studied medicine in Nijmegen (NL). He was trained as an anaesthesiologist in Leiden (NL) and emergency physician in Leuven (Belgium). After he completed his training, he worked as an anaesthesiologist and Intensive Care physician (Venlo, NL) and head of the department of Intensive Care and Hyperbaric Medicine (Antwerp, Belgium). At this moment he is the head of the Department of Anesthesiology of the VU University Medical Center in Amsterdam (NL). In February 2002 he was appointed as Professor in Emergency Medicine at the Department of anesthesiology. The hospital has a function as a supra-regional level I trauma centre and is the ground station for a helicopter mobile medical team. His major fields of attention include emergency and disaster medicine.

The scientific interest in water-related injuries started when he worked as a professional lifeguard during medical school vacations. During his medical career he published more than 80 articles and chapters on drowning, hypothermia and water safety. In 1996 he completed the PhD thesis “Drowning in the Netherlands. Pathophysiology, epidemiology and clinical studies”. He is a regular national and international invited speaker and teacher on these subjects, from a practical rescue level to the clinical intensive care level. He is affiliated to several organisations in this field such as the Royal Dutch Orange Cross, Royal Dutch Lifeboat Institution and the Medical Commission of the International Life Saving Federation. Since the origin of the idea to obtain a global focus on the issue of drowning in 1996, he serves as project co-ordinator of the World Congress on Drowning.

In addition to the activities in the field of water safety, Dr. Joost Bierens is involved in research, education and strategy planning in several other fields such as intubation, infection prevention, medical ethics, diving medicine, resuscitation, emergency medicine and disaster medicine. He has published several articles and chapters in books and presented scientific papers on these topics. He is a member of the Editorial Board of the European Journal of Emergency Medicine.

Biography

Drowning – An Overview of the revised handbook. Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning).

Dr. David Szpilman (Brazil)

David Szpilman graduated from medicine in 1982. He completed his medical residency jobs during 1982 to 1985 as a specialist in internal medicine and intensive care with a focus on drowning, after which he quickly became head of the intensive care unit of the Hospital Municipal Miguel Couto in Rio de Janeiro, Brazil. Additionally, he became the doctor for the Fire Department in the State of Rio de Janeiro where he was head of the Drowning Recovery Center for 12 years. His current roles involve; board member of medical commission of International Lifesaving Federation (ILS); founding partner, ex-president and current medical director of the Brazilian society of aquatic rescue – SOBRASA; member of the Technical Chamber of sports medicine of the CREMERJ; medical reviewer of journals “Resuscitation” and the “New England Journal of Medicine“. He is the author of 4 books, 61 book chapters and more than 127 national and international medical articles on drowning. He is a frequent guest lecturer worldwide, and has presented at many conferences across the globe; 390 lectures in Brazil, and 22 International (Belgium, Hungary, England (2), Spain (3), UNITED STATES (4), Argentina (3), Venezuela, Uruguay, Italy, the Netherlands, Portugal (2), Ireland, and Australia).

Prof. Mike Tipton (Portsmouth, UK)

Educated at the Universities of Keele and London, Prof. Tipton joined the University of Surrey in 1986. After 12 years at the Robens Institute and European Institute of Health and Medical Science he moved to the University of Portsmouth in 1998. In addition to his University positions, Professor Tipton was based at the Institute of Naval Medicine (INM) from 1983 to 2004 and was Consultant Head of the Environmental Medicine Division of the INM from 1996. He has spent over 30 years researching and advising the military, industry and elite sports people in the areas of thermoregulation, environmental and occupational physiology and survival in the sea. He has published over 500 scientific papers, reports, chapters and books in these areas.

Professor Tipton has been a Consultant in Survival and Thermal Medicine to the Royal Air Force and UKSport; he sits on the Royal National Lifeboat Institution (RNLI) Medical and Survival Committee, and the Ectodermal Dysplasia Society’s Medical Advisory Board. In 2004, Prof. Tipton was made an Honorary Life Member of the International Association for Safety & Survival Training (IASST) in recognition of his work in sea survival. He chaired UKSport’s Research Advisory Group and now sits on the English Institute of Sports’ Technical Advisory Group. Prof. Tipton chairs the Energy Institute’s Health Technical Committee; he a Trustee of Surf Lifesaving GB and Senior Editor of the journalExtreme Physiology and Medicine. Prof. Tipton is a Fellow of the Royal Society of Medicine, he provides advice to a range of universities, government departments, industries, medical, search and rescue, and media organisations.

Dr. Brian Tissot (California, USA)

Professor Tissot is a surfer and a marine ecologist with over three decades of experience conducting research on temperate and tropical marine ecosystems. He received his Ph.D. in Zoology from Oregon State University and has held positions at the University of Hawaii and Washington State University. He currently serves as the Director of the Marine Laboratory at Humboldt State University and lives in Trinidad, CA. He has published over 70 papers in scientific journals and has been awarded over $7 million in research grants in his career and serves on multiple scientific advisory boards. Brian’s work has been featured in Scientific American, Smithsonian magazine, the Washington Post and several films.

His Benthic Ecology Laboratory is focused on scientific research that improves the understanding, management and conservation of marine ecosystems. In collaboration with local communities, agencies, and a variety of other organizations, he develops and implements innovative solutions to marine resource issues. Working in Hawaii for the last 20 years, Dr. Tissot and his colleagues have improved the management of the aquarium fishery along the Kona coast by developing a community-based, collaborative research program on marine protected areas. Along the California and Oregon coasts he has worked on deep sea fisheries and their effects on structure-forming invertebrates and his research has been used to formulate management strategies for bottom trawling and protecting essential fish habitat.

In addition to his scientific research Tissot (aka “Dr. Abalone”) also produces surfing videos on YouTube and blogs about surfing, marine biology and environmental issues on his site BrianTissot.com.

Biography

Coming Soon …

Stay tuned to the Homepage / Facebook / Twitter / Instagram / Vimeo over the coming days and weeks for more information on the 4th Annual Conference in Surfing Medicine and Keynote Speaker announcements!

Registration

“Cold water immersion – treatment and practicalities in the field” by Dr. Patrick Buck PhD REMT

Treating a drowning or hypothermic casualty in the field will always present a number of challenges for a first responder. Psychological stressors, lack of equipment, unfamiliar terrain and perhaps hostile conditions can combine to make the task formidable.

It is for this reason that pre hospital or First Responder training should focus on preventative strategies, prevention is always better than cure and on imparting a set of simplified methodologies for treating and managing such incidents in the field.

When someone falls into cold water four things happen over time. Firstly they will experience a level of Cold Shock which usually lasts between 1 – 3 minutes (stage 1), followed by Cold Incapacitation, which sets in at around 15 minutes (stage 2) and then Hypothermia which may take 30 – 60 minutes to develop (stage 3). The rate at which hypothermia develops is related to several factors including body composition, clothing at time of immersion, atmospheric conditions, water state and water temperature.

Finally some level of Post Rescue Collapse will occur (stage 4). This is of course providing that the casualty has not already drowned through swim failure. Without a Personal Floatation Device (PFD), many people in cold water will drown prior to becoming hypothermic because as their muscles stiffen and cramp, it will get progressively more difficult for them to keep their airway from becoming compromised.

Post Rescue Collapse, also known as Circum Rescue Collapse or Peri Rescue Collapse, can be, and often is, fatal. An estimated 20% of conscious and viable hypothermic casualties recovered from cold water die as a consequence of Post Rescue Collapse either before, during or after rescue.

The primary goal for a First Responder when treating a hypothermic casualty in a pre hospital setting is to try and prevent further heat loss (core body temperature (CBT) drop). In addition as a ‘cold heart is a fragile heart’, every effort should be made to treat the casualty as gently as possible and to avoid any rough handling. Ventricular fibrillation is a very real possibility in a hypothermic casualty and in many cases will prove fatal if initiated through incorrect handling or improper rewarming strategies.

As most First Responders are unable in a field setting, due to lack of appropriate equipment, to determine a casualty’s CBT, all obviously hypothermic casualties should be considered as serious until proven otherwise. As a consequence a casualty should not assist in their rescue nor be encouraged to partake in their treatment, like removing their own wet clothes.

Clinical signs can provide an indication of the casualty’s level of hypothermia, which may in turn assist in their management.

If a casualty is shivering but is mentally and physically alert and is acting normally then they are most likely just cold or very mildly hypothermic.

If a suspected hypothermic casualty is conscious and shivering then their CBT is most likely at or above 32°C.

If a conscious casualty who is obviously hypothermic but is not shivering then their CBT is probably in the region of 30°C-32°C. Note not everyone shivers.

If paradoxical undressing occurs then the casualty probably has a CBT between 30°C -32°C.

If a suspected hypothermic casualty is unconscious then their CBT is most likely below 30°C. Of course they may have sustained other injuries or have drowned.

Casualty rewarming strategies, where possible, should be initiated in the field.

Rewarming can be achieved using a number of different strategies depending on casualty presentation.

Passive external rewarming.

Active external rewarming.

Active internal rewarming.

A hypothermic casualty with a CBT above 32°C can be treated with insulated blankets, dry clothing, burrito wrapping and warm sweet drinks. They will be able to rewarm spontaneously.

A hypothermic casualty with a CBT below 32°C will require active rewarming management. These casualty’s cannot rewarm spontaneously and will require the addition of heat.

In conclusion it must be stressed that every case should be managed on a casualty by casualty basis. In addition a casualty’s treatment must not compromise other members of the party or group. Multiple casualties present a much more significant challenge for a First Responder in a pre hospital setting.

Finally a Hypothermic Casualty Is Never Dead Until They Are Warm And Dead Unless Patently Dead.

Dr. Patrick Buck, Ph.D REMT, is a marine biologist, educator, adventurer and environmentalist. He is currently Director of Inland Fisheries in the SW of Ireland. Patrick has extensive experience in marine survival and a deep passion for remote medicine and its application in the marine environment. He is currently conducting applied research in the area of marine survival and hypothermia and is specifically interested in modified PFD design to prolong life in austere settings. He is an avid water sports enthusiast with over 40 years experience in surfing, kayaking and marine guiding. Patrick is a director of WATER SAFETY 4 ALL, a ‘not for profit’ organisation dedicated to bringing safety and fun to all water users from all walks of life.

Dr. Buck is the author of “A field guide for the treatment of drowning, hypothermia & cold water immersion incidents”. This guide is available through the WATER SAFETY 4 ALL website: http://watersafety.eu It is also available from Amazon.com as an E-book (immediately) or physical book (from 30th January 2015 onward) at select book shops.

“Field Notes from the Pipeline” by Dr.Terry Farrell

2014 World Champion Gabriel Medina Photo Credit: The Guardian

This year’s Billabong Pipe Masters was a very special event for many reasons. The event was held in honor of Andy Irons, who passed away in 2011. It marked a changing of the guard, with Gabriel Medina ushered in as the new world champion and first from Brazil. Julian Wilson of Australia captured the Vans Triple Crown and the Billabong Pipemasters with one of the most exciting final heats in the history of the event.

At 20, Medina was joint tie with Kelly for youngest World Champ every!

But for me, the main reason was that I was able to attend as the emergency physician for the event. The only tricky part was that I had only about a month to get the active Hawaii license and malpractice insurance required to work at the event.

The physicians on the team included Leland Dao, a local physician with 17 years of experience at the event, Spencer Chang (an orthopedist) and me. The staff also included a physical therapist, a massage therapist and a chiropractor.

Pipe Docs! Dr.Farrell (Left)

We had front-row seats for the event and were stationed just up the beach from the water safety tent and clearing area for the jet skis. We were in an ideal position to respond to an emergency as it reached the shore.

Injuries …

The types of injuries we saw included minor lacerations to the face and feet, musculoskeletal strain and sprains, ear complaints such as ruptured TM and otitis externa, one dog bite and one large leg laceration from a fall. The most significant injury, a splenic laceration, happened to a non-competitor on one of the lay days. Three of the competitors had shoulder injuries: two AC joint separations and one dislocation.

Wounded Warrior: Shoulder Injury

Ready & Prepared!

Thankfully there were no cervical spine injuries and no resuscitation needed during the event. We did run a mock scenario on the second day of the competition to test the system and used all of our airway, splinting and immobilization equipment to practice our roles in the medical team and work with the water safety team.

The second day of the contest was amazing. The waves were 15 to 18 feet high and closing into three feet of water overlying an unforgiving jagged coral reef. That is when I realized how talented these surfers are – an impression cemented later that day when Jamie O’Brien and two friends free-surfed on pink foam boards into 15 foot pipeline barrels for fun. This was the day I realized the importance of my preparation for the event. The risks in surfing are real, and the medical preparation has to adjust to the location and intensity of each event. The lessons learned in the ASLS course have direct application whether you are surfing with friends or attending a professional surfing event.

Dr.Terry Farrell

Dr.Terry Farrell is a practicing Emergency Medicine physician and provides medical support for professional surfers at World Surf League (WSL), formerly the Association of Surfing Professionals (ASP), contest events. He is Board Certified in Emergency Medicine and Family Practice. Dr. Farrell lectured on the topic of head trauma and traumatic brain injury seen in surfing at the 3rd Annual Conference in Surfing Medicine. He will instruct at the upcoming ASLS Course 2015 later this year.

Professional Medical Support Teams for Athletes

Increasing professionalism in surfing has widespread implications, not only for surfers, but also for the health professionals who look after these athletes at contest events. Dr.Leland Dao discusses this issue and highlights the key role played by medical support teams in the above clip.

The European Association of Surfing Doctors wishes you and yours a very Merry Christmas and Happy New Year!

OK, it’s that time of year again and Christmas is creeping up on us fast. Before you know it, you’ll be loosening the top button – Homer Simpson style – after a festive turkey feast!

For those of us graced with waves this Christmas, we may be tempted into the water despite the seasonal chill. It seems quite intuitive; indeed, prudent public-information notices, such as that shown here by Irish Water Safety, remind us not to enter the water immediately after eating. But when the surf is pumping … well, you know, it can be difficult to sit on the beach.

I recently came out of the water to be greeted by the not-so-pleasant retching of an overzealous grommet. When I approached him, asking if he was all right. He replied:

“I was starving, wolfed down my lunch before getting in … wicked heartburn!”

Long story cut short, he lived. But the episode brought to mind a distant Friday Facebook Fact (FFF) about a study looking at Gastrointestinal (GI) symptoms in surfer populations.

Paddling (Prone) at Conference 2014

Back in 2009, that’s exactly what Norisue et al. examined. Their study compared the prevalence (i.e. how common an occurrence) of GastroEsophageal Reﬂux Disease (GERD) in surfers versus non-surfers who participate in other sports.

How did they do that?

Their hypothesis was based the fact that paddling in the prone position, i.e. lying on your stomach, on hard surfboard surfaces leads to raised pressure within the abdomen and hence GERD. The authors used a modified version of a validated questionnaire survey called the Gastrointestinal Symptom Rating Scale and obtained their data from 185 surfers and 178 non-surfer athletes on the Hawaiian Island of Oahu. They also collected information on risk factors (things that increase your likelihood of developing a given condition) for GERD, type of surfboard ridden, frequency of surfing, and duration of surfing experience.

What did they find out?

The prevalence of GERD was signiﬁcantly higher in shortboard riders than in non-surfers with an odds ratio of 4.6 (28% versus 7%, P<0.001) after adjustment for demographic variables using the multivariate regression model. GERD was more prevalent in shortboarders than longboarders (28% and 12%, respectively). Furthermore, the more frequently you surfed, and the longer your surfing history, GERD increased signiﬁcantly (P<0.001).